Environmental Consultation Request Form Environmental Consultation Request Form Environmental Consultation Request FormFull name Company / Establishment Name (if any):Legal Status of the Establishment Individual Other Establishment Company Government Entity Commercial Registration Number City / Region Detailed Site AddressContact Information Contact Person NameJob Title Mobile number Email Address Preferred Method of Contact Email WhatsApp Phone Call Type of Activity Main Activity Type Educational Medical Construction Other Industrial Commercial Agricultural ServiceOther (please specify) Brief Description of the Activity and Its NatureActivity Status Under Construction Planned (New Project) ExistingProject Location Region / Governorate City Is the site located within Commercial Area Residential Area Industrial Area Mixed-Use Area Site Coordinates (if available)Type of Service Requested Is the site located within Preparation of Environmental Management Plan (EMP) Environmental Measurements (Air – Water – Noise – Soil) Other Support in Obtaining Environmental Permit Preparation of Environmental Register Environmental Classification (Category A, B, C) Preparation / Review of Environmental Impact Assessment (EIA) General Environmental Consultation Compliance Assessment with Environmental Regulations Handling Environmental Violation or NoticeOther (please specify)Relevant Regulatory Authority (if any)Relevant Regulatory Authority (if any) Civil Defense Municipality Other Ministry of Environment, Water and Agriculture National Center for Environmental Compliance (NCEC) Ministry of IndustryCurrent Environmental Status of the Site Has an environmental permit been previously obtained? Yes NO Is there a previous Environmental Impact Assessment? NO YesAre there any environmental violations or observations? NO Yes If yes, please specifySources of Environmental Impact (if any)Are there any environmental violations or observations? Noise Odors Industrial / sanitary wastewater Other Chemicals Air emissions Hazardous waste Solid wasteAttached Documents (Optional)Attached Documents (Optional) Site plan Industrial / sanitary wastewater Commercial registration Air emissions Site photos Activity license Previous environmental studies Site layout / drawingsAdditional DetailsAdditional DetailsDeclarationI hereby declare that the information provided above is accurate and correct, and I agree to its use for the purpose of reviewing the request and contacting me regarding the requested service. I AgreeNamethe datesend
